COB Coordinator

Doctors Healthcare Plans•Coral Gables, FL

About The Position

The Main function of a COB Coordinator is to coordinate benefits between Doctors Healthcare Plans, Inc. and other insurance carriers that may be liable for the services provided to our members. This role involves analyzing, processing, researching, and adjudicating claims that involve other insurance carriers, ensuring timely processing according to CMS guidelines. The coordinator will investigate members for other insurance, manage questionnaires and correspondence with members and providers, and maintain quality standards in all research and adjustment functions. The position also requires accurate data entry, adherence to online policies and procedures, and acting as a liaison for special claims handling. Effective communication, a positive problem-solving attitude, and compliance with company policies and all relevant regulations (HIPAA, OSHA, etc.) are essential. Participation in meetings and training is also expected.

Requirements

Excellent oral and written communication skills
1 – 3 years of Health claims processing experience
Working knowledge of COB and MSP preferably
Working knowledge of medical terminology
Working knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
Excellent organizational skills
Ability to work well under pressure in difficult situations
Bilingual: English / Spanish (Required)

Responsibilities

Analyze, process, research and adjudicate claims that involve other insurance carriers.
Process and monitor COB claims according to CMS guidelines.
Investigates members for other insurance through phone calls and correspondence but not limited to claim adjustment requests or appeals.
Responsible for send and monitor questionnaires / letter sent to members and providers.
Responsible for timely processing of COB claims.
Maintains quality standards in all research and adjustment functions.
Enter claims or verify data entry for accuracy and completeness.
Uses online policies and procedures to ensure accuracy in claims processing.
Acts in liaison to providers and members for special claims handling.
Contributes to team effort by accomplishing related results as needed.
Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
Promotes and contributes to a positive, problem-solving environment.
Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
Participates in meetings, training and in-service education, as required.
Performs other duties as assigned.